CT scan results - verbatim

For those of you that have not had the opportunity to undergo a CT scan, it is not the most unpleasant diagnostic examination that you can experience. CT is the abbreviation for "Computed axial Tomography," which is sometimes referred to as "CAT," and it is basically an x-ray machine that spins around your body continuously recording digital data about your insides. It takes about five minutes, once you have ingested two quarts' worth of barium sulfate milkshakes over an hour (I chose the vanilla over the berry flavor) and are injected with an additional IV contrast agent (iodine-based, clear solution) during the scan itself. My PowerPort was accessed for this IV, making the whole process pretty straightforward. The oral contrast (barium sulfate) makes it easier to identify the stomach and intestines, and the IV contrast (iodine) makes it easier to "see" my blood vessels and heart. Both contrast agents are eliminated by my liver and kidneys. By the way, the IV contrast agent makes you feel warm inside (one CT technician warned me that it might make me feel like I'd wet my pants - but my experience was more of a warm, metallic tongue first and then a very slightly sweaty sensation spreading down my body and then up into my head). Then the table that I was laying on slides into a circular tunnel (not claustrophobic at all), the scanner starts to slowly spin around me, and a feminine machine voice says, "Breathe in and hold your breath." The table slowly slides out of the machine, and the voice says, "Breathe." It's good to be reminded to breathe every so often. And now we're all done.

Except for the waiting.

Since I am meeting with my oncologist on Wednesday next week and need to take the imagery/results with me, I asked the CT technician when the scan results would be available. He said that I could pick up the digital imagery immediately (since it is digital and all!), but that the radiologist would not look at the images until later that day. So I picked up the imagery and final report the next afternoon, and here is what it says [comments in square brackets are mine]:

HISTORY: Followup colon cancer in a 46-year-old male. He was initially diagnosed in March 2007. He underwent surgical resection in June 2007 [actually, the surgery was in April 2007, and chemo began in June]. Since that time, he has been treated with chemotherapy.

PROCEDURE: Following administration of oral and IV contrast, axial 5mm images were obtained from the lung apices [plural of apex - the top of the lungs] through the symphysis pubis [just below the bladder, basically].

FINDINGS: The lungs remain clear. No developing mass or nodule seen in either lung. No local infiltrate is present bilaterally [I believe that this is a redundant sentence, given the one immediately preceding it, but it might mean that the radiologist did not see any symmetrical "features" that should not be there]. No pleural effusion [excess fluid in the space around the lungs] is present bilaterally and no pericardial effusion [fluid around the heart] is seen. No areas of pleural thickening [increase in the width of the pleura - the lining of the sac that surrounds the lungs] are identified. No developing adenopathy [large/swollen lymph nodes] is seen within the chest. Heart size is normal [whew!].

The liver is normal in size. Numerous small low density nodules are again seen throughout the liver, which measure up to a maximum of about 11mm. All of these nodules were seen on the prior study from 5/22/2007 and appear stable in size and number. No enlarging or new mass is seen within the liver. The gallbladder, bile ducts, and pancreas appear normal. The spleen is normal in size. A tiny low density nodule [this usually means "fluid-filled" and is not cancerous] is seen on image 51, measuring about 6mm. This was present on the study from 5/22/2007 and has diminished in size. Adrenal glands and kidneys appear normal.

Postsurgical changes are present within the pelvis. A suture line is noted at the rectosigmoid junction [where the rectum connects with the large intestine] compatible with partial colonic resection [the surgery I had]. The remaining colon appears unremarkable [my new favorite diagnostic word!]. No areas of bowel wall thickening are seen. Small bowel appears unremarkable. No dilated bowel loops are present. No developing adenopathy is seen within the abdomen or pelvis. No ascites [accumulation of fluid in the peritoneal cavity - basically the area below your lungs and above your crotch] is present. Bladder appears unremarkable.

IMPRESSION:
1. No evidence for developing metastatic disease or recurrent neoplastic disease within the chest, abdomen, and pelvis.
2. Clear lungs.
3. Stable appearance and number of multiple small low density nodules in the liver. A prior ultrasound was performed on 3/29/2007, showing these to represent cysts. No new or enlarging mass is seen within the liver.
4. No developing adenopathy is seen within the chest, abdomen, and pelvis.
5. Postsurgical changes related to partial distal [toward the end] colon resection. Area of anastomosis [the site of the surgical reconnection of the two parts of my colon] appears unremarkable, without developing wall thickening. No adenopathy is seen within this region.
6. No ascites is present.
7. Tiny nonspecific low density nodule is seen at the anterior margin of the spleen, diminished in size when compared with the study on 5/22/2007.

So, with the caveat that I have not spoken to my oncologist yet, I think this CT scan result bespeaks quite good news. Thanks for your interest and attention, and you will now be returned to your regularly scheduled programming....

Respite

Hello. Remember me? I've been "off-blog" for nearly a month now, and have been feeling more and more guilty about that. So, where have I been, you ask? Well, I have been wallowing in the distraction of not having any more chemo-therapy to endure. I have been swimming in the warm waters of a slowly healing body, experiencing the flavors of beer, wine, scotch, and ethnic foods as often as possible. In short, I have been trying to reclaim some semblance of normalcy at the end of Ed's cancer-year.

My fingertips tingle a bit all the time, but especially when I exert any pressure with them (like typing) - and I have a lot of trouble with the collar buttons on my work shirts each morning. I mistrust my fine finger coordination, and have found that I drop things more often than I think I should. My feet tingle constantly too - and this is especially difficult at night (when I think that my feet are extremely cold but they are just, ummmm, tingling).

I would say, though, that getting *away* from cancer-world is virtually impossible. My family and I went on a very relaxing cruise in the Eastern Caribbean. We enjoyed warm weather, calm seas, wonderful meals and no responsibilities for seven straight days. We enjoyed each other's company as well as the companionship of several hundred strangers, and were treated royally by the staff and crew of the Celebrity Millennium. We frolicked on tropical beaches, we enjoyed the massages, the tropical fishes, and the shopping in far-off ports. In short, we had a lot of fun. But I couldn't seem to shake the nagging feeling that my world is still shifted from the *way it was*. My port is still bulging out of my upper-right chest, and I know I have a CT scan tomorrow and an appointment with my oncologist next Wednesday.

Respite - a break from the way things are - is essential. "Vacation" is an Americanism that I have never found to encourage relaxation. I tend to try to force too much *stuff* into too little time, and end up stressing out about the content of that time. This cruise ended up being a great respite for me, but only after a couple days' worth of stress about spending money and over-planning daily activities. I am so glad that we went, and glad for the companionship of my wife, my daughter, and my brother-in-law... and for the anonymity of cruising with strangers. Sometimes getting away from "it all" is impossible, but we managed to get away from most of it. And for this I am most grateful!

Toxic clouds with silver linings

OK. I was scheduled to get my 11th (and last) treatment last Thursday. At the previous monthly appointment with my doctor, we had talked about the endgame for my chemo-therapy, and had agreed that the "final" (12th) treatment could be avoided. (Given that my family has had a special vacation planned for December to celebrate the end of chemo, I had decided that I did not want to spend any vacation time feeling chemo-crummy.) So, #11 on November 29 would be the last one... if my blood work was OK. On the 28th I had a blood test to see if the trip to Portland was even needed (this after a reduced dosage of both oxaliplatin and fluorouracil during treatment #10 AND five injections of neupogen to encourage the growth of white cells and neutrophils). The results were mixed (WBC was too low - 2.7 when I need at least 3.0 - while the ANC was a protocol-minimum 1.5), so we decided that it was worth the trip on the 29th.

No go. The blood work up at the clinic in Portland was significantly different from the previous day's test results. WBC was a 2.1 and ANC was 1.3, both far too low to withstand the impact of chemo-therapy. No treatment #11 (unless I want to, ummm, come back a week later for another roll of the bloodwork dice). No thank you, really. I did not get treatment #11, and #12 is off the calendar completely. I need to enjoy this vacation, and I want my family to be able to enjoy it even more. Being tired, and cranky-stinky - well, that doesn't sound like a fun guy to be (or be with) on a vacation. So, the chemo-therapy part of this colon cancer thing is over! But, what about the implications for my "cure" probability?

I am not qualified in any medical sense to speak authoritatively on that question. But, ten solid treatments are under my proverbial belt, though there have been three increasingly difficult delays. Peripheral neuropathy on the rise, even with decreasing dosages. I trust that my body has been hammered pretty hard by this treatment regimen, and that it is telling me that it has had enough. And everyone is different - on so many levels - that the prescribed length and dosage of treatment must be a variable that is flexible. The toxicity of the chemicals used to treat cancer is intentional, in order to wipe out those hypothetically "fast-growing" cancer cells. My body has been surprisingly strong in dealing with the bi-weekly introduction of liquid poison. My fingertips and feet tingle all the time, and I am very sensitive to cold and heat. My insides are producing gases that should not EVER be released in an enclosed space. And the high fatigue right after treatment had extended from 4 days to about 6 days... and now all of that is only going to improve!

Every day is a day closer to a new normalcy, without the added mental weight of anticipating negative blood counts or the infusion of toxic chemistry. I can work on strength recovery, and look forward to daily walks to work. And the vacation is just around the corner.

Now that's a silver lining.

(PS - the next step is a CT scan on December 27th to check the status of my insides (basically looking for anything unusual) followed by a post-chemo appointment with my oncologist in early January and a colonoscopy later in the spring.)

Ignorance and bliss...

I have not felt the need to "publicly" respond to any of the comments that I receive related to my posts has been necessary before. My general sense is that most comments are of the "keep your chin up" or "thanks for sharing" variety. And while I certainly appreciate the support that those type of comments provide, they have not caused me to want to post a response. However, three versions of one question were posted the other day related to one of my blog entries, and I feel somewhat compelled to pontificate...

"Do you feel your experience with cancer has been more difficult as an intellectually sound individual? Has the pro-active spirit made the journey mentally taxing as well as physically? I guess what I'm trying to say is do you sometimes feel others are fortunate with an ignorance is bliss attitude?"

First, I appreciate being called an "intellectually sound individual." Some days I am not so sure that's the case. :) But the question is still out there, and my experience with cancer is what this blog is all about. Yes, the journey HAS been damned difficult... and not only for me. Chemo-therapy and the odd mixture of side effect management drugs is very distracting on so many levels - but I have already blogged (ad nauseum - pun intended) about those issues. I regularly see the world through a different lens than I ever could have imagined using prior to becoming a member of the cancer club. But the idea of "more difficult" than some other person's journey troubles me. I am not sure that any one else's cancer journey is qualitatively comparable to mine, and I have a hard time imagining my new life journey (one, perhaps, dulled by drugs?) that is so different from the one that I am living. Every cancer treatment regimen is ultimately an experiment of one... an experiment that is statistically informed by the individual treatment "experiments" that preceded it. I am lucky to have been diagnosed now (as opposed to a decade ago), and to be otherwise healthy enough to handle the chemo-therapy. I'm not sure if that is a good answer to the gist of the question, but there it is.

So, let's consider the second approach to the question - about mental taxation and a pro-active spirit. (Again, my thanks to the comment-poster for the complimentary manner in which this question is raised.) I, "Mr. He-Who-Must-Analyze-Everything", cannot imagine being less active than I have been. But yes, that does add to the mental anguish I feel about the way that my experience of the world has changed. And by extension I am sure that the energy I devote to thinking about, researching, analyzing, questioning, and re-analyzing the details of my diagnosis and treatments is not available to my physical self. This begs another question/observation though: would I have it any other way (or perhaps more accurately, can I imagine myself not doing these things)? Not really. I am what I am (apologies to Popeye), and that means constantly re-examining what I know and what that means about my world. So, yes it is more taxing to be self-aware and proactive about my life as a cancer survivor than my life before the diagnosis - but only because I have a new reality to understand and embrace.

I am unsure how I should approach the last approach. "Ignorance is bliss" is one of those aphorisms that I only partially understand. I can accept that there are only so many issues or processes or whatever that one human mind can hold and consciously act upon. Can I really affect the abject poverty of sub-Saharan Africa - caused by centuries of tribal and colonial machinations layered atop environmental changes that transcend locale? What about the plight of homeless persons, with the multiple facets of modern existence that confound their ability to successfully interact with their own cultures? I am (selectively?) ignorant about the details of these situations as I work to handle the complications of a cancer in my life - and might consider that ignorance to be a kind of bliss. But applying that attitude to how one deals with a cancer diagnosis (or any other significant, life-threatening event) doesn't work so well for me. I cannot detach the analytical, proactive aspects of my "self" so as to be able to imagine how it might feel (better or worse) without those characteristics. And it is hard to imagine "not knowing" about a cancer (or the details of the diagnosis, prognosis, treatment, and recovery) as being somehow better than knowing... but that can only apply to me.

Cancer sucks. Period. There is really no blissful ignorance to wallow in once the "c" word enters your life. My friends and family have tolerated my somewhat compulsive, detail-oriented approach to colon cancer, and have encouraged me to find whatever way forward I need. I have been a cranky dude at times, and that has made it difficult for my nearest and dearest support group. On many occasions I have felt the need to apologize for unfortunate utterances (due to fatigue, or chemo-brain, or just plain tiredness). But soon, the transfusions will be finished and I will be moving back toward a "normal" life - whatever the hell that means.

So, the summary answer? Cancer is hard on everyone it touches, however directly or indirectly. Being proactive or hyper-analytical does not change that statement overmuch. We all struggle to decide how much we need to know about some aspect of our lives, and we make decisions based on the amount of information we feel is "enough." I am sure that there is a spectrum of "responses" to this line of questioning, and it's certainly possible that I am a statistical outlier. (I know some people that would argue that that "possibility" is close to 100% likely!) I feel lucky to be who and what I am, and to know that I can rely on a strong, supportive community for support. And that's what matters.

Plumbing

Sitting here on Thanksgiving morning, in the relative quiet before the annual storm of friendship descends upon our kitchen and dining room, I wonder how often we really think about the infrastructure of our lives. My day-to-day routine just seems to happen, you know? Some alarm goes off (mine is internal and seems to be pegged on 6am local time - wherever that happens to be), and I begin the day. Most days, this involves some level of external light (sun rising over wisps of fog in the park, a hint of grey light in the eastern sky, or even a blast of golden energy into our second story bedroom) and sound (the steady thrumming of raindrops that are moving through the gutter system outside the window, wind flap-flap-flapping the sign that announces yet another years' holiday sale at the art museum across the street, the Amtrak commuter line to Portland announcing that yes, again, it is heading up the tracks, or even the background street noise from earlier-risers on Liberty and Mission Streets making their way to someplace else). Today is quiet and dark.

I go downstairs to perform ablutions - shaving with an electric razor (to avoid those nasty and potentially infected nicks and cuts), counting the remaining hairs on the top of my head, showering off all of the sleepiness and such. I turn the faucet handle at the sink to rinse off my razor, and clear cold water appears to do my bidding. Seconds later, bearing its micro-burden of beard remnants, that water whisks itself down a little hole and disappears back into the greater puddle we call our sanitary sewer system. Quite the little feat, there, and all assumed and trusted every day of our lives. As they say, "out of sight - out of mind." The water lines coming in to the house, and the sanitary sewer lines that drain our house, are hidden and silent behind lath-and-plaster, PVC, cast iron, and dirt. Yet our lives are so dependent on this hidden engineering.

The upstairs bathroom sink - a high-traffic area for us in the morning and evening - is draining poorly these days. And that means consideration of its health... Are we just looking at a hair/soap scum problem that can be removed by chemical or physical means? Are we talking about some exploratory pipe-work (always a little nerve-wracking, since the exploration can cause damage to water seals and pipe threads, and you may discover a systemic rather than localized problem!)? Do I have the skill, the tools, the replacement supplies... all that I will need to explore and then re-connect my vital sink infrastructure before it is needed again for tooth-brushing and face-washing and the like...?? Oh, the trouble this little drain may cause!

And all about a simple little sink drain! "Can't we call a guy" and make this whole thing go away? Pay someone to bear the burden of uncertainty and to assume the mantle of authority when it comes to diagnosis, prognosis, system design, and reconstruction? Geez. Let's try to plunge it first, then pour some chemicals in... we can always "call a guy" later, right? He'll come in and fix it up like new, no matter what we do first... uh, right?

Funny little story, eh? Variants on this story happen millions of times every day, and with only the smallest of repercussions across the infrastructure of our lives. But then again, take out a major highway bridge across the Mississippi River, or flood out the pumps that keep Manhattan's water table below the level of the deepest subway, or even ignore a backed up sink drain for a couple days, and all hell breaks loose. Now you've got compounding problems everywhere. In my simple example, water begins to spill onto the flooring (which is the ceiling of a lower floor), or the physical/chemical initial treatment finally weakens the main drain pipe enough that a small (unseen) leak develops inside the wall and it begins a different kind of structural problem. Yikes.

We take so much for granted in our modern existence. Clean air - delivered to our lungs 24/7 due to the symbiotic functioning of sunlight and chlorophyll; clean water - evapotranspiration and filtering provided at no additional cost by sunlight and soils; safe food and shelter; and healthy bodies. We have to watch all of these things carefully, maintain their health so to speak, and I realize that there are limits to the ability of one individual/family to manage all of the huge systems that support modern living in America. But awareness and reflection - those are things we can and should control. Be aware, for your drain may be in need of some attention sometime soon. Don't ignore the warning signs, or casually procrastinate on action. Fixing the problem later may cost a lot more than you are willing (or able) to pay.

Peace, and have a joyous day of thanks. I know I will!

What's up with these hiccups?

So, I guess I am truly back in the land of chemo-therapy. The hiccups have plagued me throughout the day, and none so much as during a public lecture tonight. Sitting in the middle front, I am sure that the speaker could hear every one of them over the course of the hour. Should you ever read my blog, Prof. Prothero, I am sorry if they were any kind of distraction for you... they sure bugged the crap out of me! But these little irritating side effects must mean that the chemo is back on the job.

So, we also had a lengthy discussion with Dr. Blanke, where we talked about the value of each additional treatment to my overall survival, we talked about the December cruise, we talked about the study protocol and my cell counts. The survival numbers apparently are increased by a couple of percentage points with each of the later treatments (the takeaway here is that the earlier treatments are much more important than the later ones), the December cruise (and my unwillingness to travel as a tired, wiped out chemo patient) is definitely on for mid-December and I will not be receiving treatment after November 28 (hopefully, #11), and the study protocols for treatment are absolutely no different than the standard FOLFOX treatment that I would have received at Salem Hospital.

For those of you data hounds (you know who you are!), all of my blood counts were in great shape - nearly as high as the blood counts that I recorded before my first treatment. The ANC was 2.6 (double last week's 1.3), and all of the others were up there too. Go figure. I am getting another series of neupogen shots (beginning on Saturday afternoon) to help support my ability to get treatment #11 on the 28th. By the way, if I can NOT get treated on the 28th due to low blood counts, then #10 will have been the last one. I am ready to be done, whichever way that particular ball bounces.

Too tired to continue this blog... but thanks for your continued interest and support.

Treatment #10

Finally, we can cross off another one of those elusive chemo-therapy treatments! This morning we drove up to the Center for Health and Well-Being (catchy name, don't you think?) and, with the help of frantically-aligned planets, karma sent toward us from around the globe, and a heavy dose of restorative rest over the past five weeks, I passed my blood test and was infused. The dosage of oxaliplatin was again reduced (now down almost 50% from the amount I received in each of the first 8 treatments), as was the 5-FU (down 25%), and I am again receiving the neupogen (1 injection daily for 5 days starting on Saturday). We are told that this delay-stuff happens routinely in about 1/3 of the cases that Dr. Blanke has seen.

So, now I will be tired again (or, MORE tired than I have been for the past several weeks). But, at most, I have two treatments left. And I'll fill you all in on the scenarios in a later post... but I needed to get the blog-post monkey off my back. Thanks for all the support, and karma.

Peace.